Dear Austin Selections Committee,
With rising healthcare costs, an aging population, and three million rural Texans with decreasing access to healthcare, it is more important than ever before that Texas control medical costs and provides sufficient access to medical care to its hardworking and taxpaying rural citizens (“State Facts Sheets: Texas”). With rural hospitals closing in Texas every year, citizens are having to decide between costly travel to cities or no care at all, both are expensive propositions. I propose that telemedicine could remedy this problem in a cost-efficient manner, provide better healthcare access to rural Texans, and reduce healthcare expenses in both the short and long term by doing so. Last year, Texas Senate Bill 1107 passed, marking a turning point for rural healthcare and telemedicine. However, the bill does have flaws as “SB 1107 requires payers to publicly publish their telemedicine payment policies” but does not “require them to pay” (Kim). SB 1107 is worth further improvement by requiring insurance companies to pay for telemedicine. Any medical policy that lacks an efficient way to pay doctors is doomed to struggle as evidenced by the Patient Protection and Affordable Care Act. I expect this issue to be supported by Democrats and Republicans alike as it builds on a previously passed bill, provides better access to healthcare for rural Texans, and is cost-efficient. Now is the opportune time to implement this change because of Texas’ aging population, rising healthcare costs, and the rural, tax-paying Texans without sufficient access to healthcare.
The immediate effects of this bill will be savings for both physicians and patients alike as healthcare expenditures are reduced by technology and framework that are already here. This is shown in the following scientific paper that does a cost comparison between rural Native American populations in New Mexico traveling to see doctors as opposed to using telemedicine: “The average per-patient cost of providing behavioral healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients” (Horn). This study demonstrated telemedicine to be less expensive than traveling to hospital visits. With companies like The Global Partnership for Telehealth developing cost-efficient software and the Centers for Medicare and Medicaid Services “seek[ing] to reduce some of the barriers to telehealth,” the technology and framework are here to provide these services and healthcare savings today (“A Georgia Non-Profit”) (“Is CMS Giving Telehealth Its Due”). National health expenditures are projected to grow 5.5 percent per year from now until 2026, resulting in 5.7 trillion dollars in expenditures by 2026 (“NHE Fact Sheet”). Though much of this is due to an aging population, Medicaid, and Medicare, state governments should support legislation with a strong theory and evidence of reducing short-term and long-term healthcare costs.
From a healthcare perspective, telemedicine “has enormous potential for mitigating the effects of the geographic maldistribution of health professionals” (Rosenblatt and Hart). This maldistribution is severe as “about 20% of the US population in rural areas, but only 9% of the nation’s physicians practice in rural communities” (Rosenblatt and Hart). Additionally, 55 million Americans are projected to be 65 or older by 2020 and 72 million Americans are projected to be 65 or older by 2030 (Ortman). An aging population incurs larger medical expenses as a significant portion of an individual’s medical expenses occur at the end of a lifespan. Rural communities have the additional complexity and cost of the lack of a “working-age [population] to help support [the] growing number of seniors” due to the younger population moving to urban areas (Casselman and King). This presents a problem for the aging rural population and a fundamental issue to rural economies. With a smaller working-age workforce in rural areas, older citizens will be more responsible for participating in and growing the already struggling rural economies. This cannot happen if they do not have access to the necessary healthcare and are not healthy. If Texas wants to support its rural economies, it should provide better healthcare access to the aging rural population through supporting and promoting telemedicine in rural communities.
Now that we have established the clear cost savings and economic benefits of telemedicine, we will briefly discuss how the technology works. Telemedicine is a broad term that refers to applications on your phone, patient portals, remote monitoring, and virtual appointments (Mayo Clinic Staff). Virtual visits use “electronic information and telecommunications technologies” such as video conferencing equipment to make these appointments possible (“What Is Telehealth?). This technology is not difficult to obtain, operate, or purchase as it is in use by businesses and institutions all around the world.
With three million rural Texans and 14 rural hospital closings in Texas since 2010, the most of any state, rural Texans have a lack of access to healthcare that is becoming worse every year and at a rate faster than any other state (Rosenblatt and Hart) (Shinneman). The reasons behind this problem are complex as they are tied to the 4.3 million Texans without health insurance and recent changes in Medicaid and Medicare policy (“Health Insurance Coverage”). However, the solution is simple. As demonstrated above, telemedicine provides cost savings to both patients and doctors alike, will benefit rural economies, and has the necessary cost-efficient technology ready to deploy to rural medical providers in Texas. This would save Texas money in both the short-term and long-term as telemedicine is an inexpensive healthcare option that would cut back on travel, rehospitalizations, emergency room visits, and provide better acute and chronic disease outcomes, resulting in a healthier and more productive workforce. Because of these cost savings, the potential short-term expenses of improving SB 1107 should not be considered. However, if they are, they should outweigh and replace less productive uses Texas’ current healthcare budget. Texas should support the telemedicine industry through amending SB 1107 to require insurance companies to pay for telemedicine and enact further legislation that benefits and promotes telemedicine.
Casselman, Ben, and Ritchie King. “Some Parts Of America Are Aging Much Faster Than Others.” FiveThirtyEight, 25 June 2015, fivethirtyeight.com/features/some-parts-of-america-are-aging-much-faster-than-others/.
“Health Insurance Coverage.” Texmed, Texas Medical Association, 22 Sept. 2016, www.texmed.org/Template.aspx?id=42282.
Horn, Brady P, et al. “A Cost Comparison of Travel Models and Behavioral Telemedicine for Rural, Native American Populations in New Mexico.” Journal of Telemedicine and Telecare, vol. 22, no. 1, 2015, pp. 47–55.,
Kim, Thomas J. “TMA Interim Written Testimony.” Texas Medical Association, 28 June 2018, www.texmed.org/Template.aspx?id=48045.
Mayo Clinic Staff. “Telehealth: Technology Meets Health Care.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Aug. 2017, www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art
“NHE Fact Sheet.” Centers for Medicare & Medicaid Services, 17 Apr. 2018, www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html.
Ortman, Jennifer M., et al. “An Aging Nation: The Older Population in the United States.” U.S. Census
Bureau, U.S. Department of Commerce, May 2014, www.census.gov/prod/2014pubs/p25-1140.pdf.
Shinneman, Shawn. “An Updated List of Rural Hospital Closures in Texas Since 2010.” D Magazine, 8 July 2018, healthcare.dmagazine.com/2018/07/08/an-updated-list-of-rural-hospital-closures-in-texas-since-2010/.
“State Facts Sheets: Texas.” United State Department of Agriculture Economic Research Service, United States Department of Agriculture, 5 Sept. 2018, data.ers.usda.gov/reports.aspx?ID=17854.
“What Is Telehealth?” Center for Connected Health Policy, The National Telehealth Policy Resource
Wicklund, Eric. “A Georgia Non-Profit Looks to Market Telehealth to Rural America.” MHealthIntelligence, 6 Aug. 2018, mhealthintelligence.com/news/a-georgia-non-profit-looks-to-market-telehealth-to-rural-america.
Wicklund, Eric. “Is CMS Giving Telehealth Its Due In Its New Rural Health Strategy?”
MHealthIntelligence, 11 May 2018, mhealthintelligence.com/news/is-cms-giving-telehealth-its-due-in-its-new-rural-health-strategy.